Clin Microbiol Infect. 2020 Aug 26:S1198-743X(20)30492-4. doi: 10.1016/j.cmi.2020.08.010. Online ahead of print.
OBJECTIVES: The objective of this study was to estimate the association of tocilizumab and corticosteroids with the risk of intubation or death in COVID-19 patients with hyperinflammatory state according to clinical and laboratory parameters.
METHODS: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 with clinical and laboratory data indicative of hyperinflammatory state. Main exposure was treatment with tocilizumab; intermediate-high dose of corticosteroids (IHDC); pulse dose of corticosteroids (PDC); combination therapy; or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTW).
RESULTS: 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively were compared with 344 not treated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratio (odds ratio for combination therapy) for the primary endpoint were 0.32 (95% CI, 0.22-0.47; p<0.001) for tocilizumab, 0.82 (0.71-1.30; p=0.82) for IHDC, 0.61 (0.43-0.86; p=0.006) for PDC, and 1.17 (0.86-1.58; p=0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p<0.001).
CONCLUSIONS: Tocilizumab might be useful in COVID-19 patients with hyperinflammatory state and should be prioritized for randomized trials.